Medicaid in Missouri 2014: To Expand or To Keep Fighting Uncle Sam?

(St. Charles, MO) – We heard it all before, last year, in the State Capitol when it comes to the argument over expanding Medicaid in Missouri.

Or did we?

The offer from Washington has not changed and neither has the political makeup in Jefferson City but supporters of expanding the state’s Medicaid roles are hopeful for a different result than last year’s. In 2013, the Republican-led Legislature soundly rejected efforts to expand the reach of the system here.

The federal government is offering to pay 100% of expanding Medicaid coverage to hundreds of thousands of Missourians for three years. After that, the state would pick up ten-percent of the cost, with the federal government paying the other 90%.

In Jen Bersdale’s opinion, that’s a great deal.

“For that ten percent, we’re going to save thousands of jobs. We’re going to create thousands of jobs. We’re going to bring Missouri tax dollars back from Washington, back to the state to take care of folks and we’re going to protect the hospitals that serve all of us, even those of us who have great health insurance.”

Bersdale is the Executive Director of Missouri Healthcare for All, an advocacy group pushing for Medicaid expansion and for the state to support the national Affordable Care Act, more commonly known as “ObamaCare”.

Former State Representative Carl Bearden once chaired the House Budget Committee. He now runs the conservative advocacy group United for Missouri. He supports the pushback against more federal government involvement in health care in the state, even if that means turning down the federal payments that go with it.

“We already know from a gold standard study in Oregon that when you expand Medicaid, health care outcomes do not significantly improve for the people who are placed on it. Costs significantly rise.”

Both sides of the debate cite differing studies that point to different results from expanding the program both in Missouri and across the nation. Many supporters of the plan say costs will not go up with Medicaid expansion.

Even if they do, Bersdale says there’s another priority to consider.

“People’s lives are on the line. Medicaid expansion is going to save people’s lives. It’s been demonstrated because people are going to get mammograms and cancer checks and blood pressure screenings.”

Still, she says expanding Medicaid and subsidizing health insurance for low income Missourians, as is being done through the national health care marketplace (exchange), is an investment that will eventually save money.

“So, the question is do we want to pay for folks’ emergency room care when they are sick and close to dying sometimes? Or, would we rather [have] our tax dollars go to keep our community healthy? Preventative care is so much less expensive.”

Bearden thinks that is missing the bigger picture. To him, any expansion of a government program is bad medicine because the costs that come with it hurts the economy. He says the new federal law’s requirements and expansion of programs like Medicaid are not cures to expensive health care, they among the factors driving up the cost of it in the first place.

“Most employers, sans ObamaCare, used to provide health care. Now you’re looking at employers who are cutting back on hours so that they don’t have to meet that standard. You have employers who may be dropping health care because of the cost associated with ObamaCare.”

There’s another part of the political and economic equation Bearden wants to keep front and center in the debate.

“All that money, that ‘free’ money we’re talking about has to be taken from individuals. It has to be taken from businesses who would spend that money much better and much more effectively in creating jobs than any job created through taxation.”

So far in the 2014 Legislative Session, efforts to expand Medicaid in Missouri are meeting a similar fate as they did last year: Republicans aren’t interested and as long as they aren’t buying, that expansion, the federal dollars and the future bill from Washington for part of the deal aren’t going anywhere.